title: Identification of important and potentially avoidable risk factors in a prospective audit study of neonatal deaths in a paediatric hospital in Vietnam.
abstract: OBJECTIVE
  Neonatal deaths (≤28 days) account for more than half of child mortality in Vietnam. Presumably most die in hospital, but data are scarce. This study aimed to identify risk factors of death among hospitalised neonates.
  
  
  METHODS
  We prospectively studied all neonatal deaths and expected deaths (discharged alive after withdrawal of life-sustaining treatment) in a Vietnamese tertiary paediatric hospital during a 12-month period in 2009-2010. The medical files were audited classifying admission prognosis, discharge outcome, cause of death/expected death according to two classifications, and important and potentially avoidable risk factors during the hospital stay.
  
  
  RESULTS
  Among 5763 neonates admitted, 235 deaths and 67 expected deaths were included. According to both classifications, major causes were congenital malformations, prematurity and severe infections. Six risk factors were identified in 85% (60/71) of the neonates with a relatively good prognosis: recognition or response to danger signs, internal transfers, nosocomial infections, sepsis management, access to usual equipment/staff, and family perception.
  
  
  CONCLUSIONS
  Among 302 neonatal deaths/expected deaths, the major causes were congenital malformations, prematurity and severe infections. Six important and potentially avoidable risk factors could be addressed in the subgroup with relatively good admission prognosis, without implementing new technology or major organisational changes.
authors.affiliation: International Child Health Research Unit, JMC, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Alexandra Y
authors.initials: AY
authors.lastname: Kruse
authors.forename: Cam N
authors.initials: CN
authors.lastname: Phuong
authors.forename: Binh T T
authors.initials: BT
authors.lastname: Ho
authors.forename: Lone G
authors.initials: LG
authors.lastname: Stensballe
authors.forename: Freddy K
authors.initials: FK
authors.lastname: Pedersen
authors.forename: Gorm
authors.initials: G
authors.lastname: Greisen
mesh_terms: D002423:Cause of Death; D000013:Congenital Abnormalities / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality*; D007239:Infections / Q000401:mortality; D008297:Male; D008485:Medical Audit; D011446:Prospective Studies; D012307:Risk Factors; D014744:Vietnam / Q000453:epidemiology; D028761:Withholding Treatment
keywords: Audit; Child mortality; Hospital; Neonatal mortality; Risk factors